Changes in posttraumatic cognitions predict changes in posttraumatic stress disorder symptoms during cognitive processing therapy.

Schumm, Jeremiah A.; Dickstein, Benjamin D.; Walter, Kristen H.; Owens, Gina P.; Chard, Kathleen M.

doi:10.1037/ccp0000040

Cited by 134 publications

(115 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This is consistent with the view of belief change as a process which underlies successful recovery from PTSD, regardless of whether this is achieved via PE, another treatment, or naturalistic improvement (Foa et al, 2006). Consistent with this theory, belief change has been found to precede PTSD improvement in other empirically-supported psychotherapies, including other CBTs like Cognitive Processing Therapy (Kleim et al, 2013; Schumm et al, 2015) and non-CBT approaches that are not clinically or theoretically focused on modifying trauma-related cognitions (e.g., McLean, Yeh et al, 2015; McLean, Su et al, 2015). …”

mentioning

confidence: 79%

Do changes in trauma-related beliefs predict PTSD symptom improvement in prolonged exposure and sertraline?

Cooper¹,

Zoellner²,

Roy‐Byrne³

et al. 2017

Journal of Consulting and Clinical Psychology

View full text Add to dashboard Cite

Objective Negative trauma-related belief change has been found to predict subsequent improvement in symptoms of posttraumatic stress disorder (PTSD) in prolonged exposure (PE) and other therapies, consistent with several psychological theories of treatment change (e.g., Foa & Kozak, 1986). However, belief change has not been examined in selective serotonin reuptake inhibitors such as sertraline. We examined processes associated with symptom improvement in two treatments for PTSD, hypothesizing that belief change would robustly predict PTSD improvement in patients treated with PE but not those treated with sertraline, reflecting moderation by treatment. Method Patients with chronic PTSD (N = 134; 78% female, 71.6% Caucasian, M = 38.1 years, SD = 11.8) received 10 weeks of PE or sertraline in a randomized controlled trial. Patients reported PTSD and depression symptoms, and trauma-related beliefs (Post-Traumatic Cognitions Inventory; Foa et al., 1999) at pre-treatment, every treatment session, and post-treatment. Results Using time-lagged mixed regression models, change in trauma-related beliefs predicted subsequent PTSD symptom improvement, an effect moderated by treatment and particularly strong in PE (d = 0.93) compared to sertraline (d = 0.35). Belief change also predicted depressive symptom improvement but more modestly and bi-directionally, with no difference by treatment modality. Conclusions Trauma-related belief change precedes PTSD improvement more robustly in PE than sertraline and with greater specificity compared to depressive symptoms. These findings highlight potentially divergent processes contributing to symptom change in these PTSD treatments, with belief change as a key mechanism of PE.

show abstract

mentioning

confidence: 79%

Do changes in trauma-related beliefs predict PTSD symptom improvement in prolonged exposure and sertraline?

Cooper¹,

Zoellner²,

Roy‐Byrne³

et al. 2017

Journal of Consulting and Clinical Psychology

View full text Add to dashboard Cite

show abstract

“…Although it has been shown that having experienced traumatic loss is associated with an increased risk of developing PTSD (Amick‐McMullan et al., ; Boelen et al., ; Green et al., ) and higher levels of PTSD severity compared with having experienced life threat events (Litz et al., ), there are no known previous studies examining the relation between traumatic loss and PTSD treatment response compared with other types of trauma. However, this alternative model is generally inconsistent with the larger literature on the association between depression and PTSD recovery, which suggests that symptoms and diagnosis of depression predict less natural (King et al, ; Tural, Önder, & Aker, ) and treatment‐led PTSD recovery (Haagen et al., ) and that improvements in depression predict reduction in PTSD symptoms throughout PTSD treatment (Keller et al., ; Schumm et al., ).…”

Section: Discussionmentioning

confidence: 99%

“…A reduction in PTSD symptoms over the course of cognitive processing therapy (CPT) was also correlated with a reduction in symptoms of depression (Galovski et al., ; Liverant, Suvak, Pineles, & Resick, ), and sudden improvements in depression during treatment were related to better PTSD treatment response (Keller, Feeny, & Zoellner, ). To our knowledge, only one treatment study has examined the relation between depression and PTSD recovery in a veteran sample; the authors found that a reduction in symptoms of depression preceded a reduction in symptoms of PTSD in veterans engaged in CPT in a residential setting (Schumm, Dickstein, Walter, Owens, & Chard, ).…”

mentioning

confidence: 99%

Depression Suppresses Treatment Response for Traumatic Loss–Related Posttraumatic Stress Disorder in Active Duty Military Personnel

Jacoby

Hale

Dillon

et al. 2019

Journal of Traumatic Stress

View full text Add to dashboard Cite

There are multiple well-established evidence-based treatments for posttraumatic stress disorder (PTSD). However, recent clinical trials have shown that combat-related PTSD in military populations is less responsive to evidence-based treatments than PTSD in most civilian populations. Traumatic death of a close friend or colleague is a common deployment-related experience for active duty military personnel. When compared with research on trauma and PTSD in general, research on traumatic loss suggests that it is related to higher prevalence and severity of PTSD symptoms. Experiencing a traumatic loss is also related to the development of prolonged grief disorder, which is highly comorbid with depression. This study examined the association between having traumatic loss-related PTSD and treatment response to cognitive processing therapy in active duty military personnel. Participants included 213 active duty service members recruited across two randomized clinical trials. Results showed that service members with primary traumatic loss-related PTSD (n = 44) recovered less from depressive symptoms than those who reported different primary traumatic events (n = 169), B = −4.40. Tests of mediation found that less depression recovery suppressed recovery from PTSD symptoms in individuals with traumatic loss-related PTSD, B = 3.75. These findings suggest that evidence-based treatments for PTSD should better accommodate loss and grief in military populations. Jeffrey S. Yarvis is now at the 21st Combat Support Hospital at Fort Hood, Texas.

show abstract

“…It is theorized that sleep disruption hinders various aspects of cognitive functioning, including emotional memory consolidation and learning (Diekelmann, Wilhelm, & Born, 2009;Walker 2010). These functions are believed integral to CPT and other trauma-focused psychotherapies, which achieve symptom reduction through processing trauma-related emotions and modifying associated beliefs (Harvey et al, 2014;Resick & Schnicke, 1993;Schumm, Dickstein, Walter, Owens, & Chard, 2015;Zalta et al, 2014).…”

mentioning

confidence: 99%

Response to Cognitive Processing Therapy in Veterans With and Without Obstructive Sleep Apnea

Mesa

Dickstein

Wooten

et al. 2017

Journal of Traumatic Stress

Self Cite

View full text Add to dashboard Cite

Recent studies have called attention to the need for enhancing treatment outcome in trauma-focused psychotherapies, such as cognitive processing therapy (CPT), with veterans. Given the prevalence of posttraumatic-related sleep disturbances, and the role of sleep in emotional learning and processing, sleep quality may be a target for improving CPT outcome. Elevated rates of obstructive sleep apnea (OSA) have been reported in samples of veterans with posttraumatic stress disorder (PTSD); however, the impact of OSA on response to CPT is unclear. In this study, CPT outcome was examined in veterans with and without a diagnosis of OSA. Following chart review, 68 OSA-positive and 276 OSA-negative veterans were identified. Generalized estimating equations were used to compare between-group differences in weekly self-reported PTSD symptomatology. The OSA-positive veterans reported greater PTSD severity over the course of treatment and at posttreatment compared with veterans without OSA (B = -0.657). Additionally, OSA-positive veterans with access to continuous positive airway pressure (CPAP) therapy reported less PTSD severity relative to OSA-positive veterans without access to CPAP (B = -0.421). Apnea appears to be a contributing factor to the reduced effectiveness of evidence-based psychotherapy for veterans with PTSD; however, preliminary evidence indicates that CPAP therapy may help mitigate the impact of OSA on treatment outcome.

show abstract

Changes in posttraumatic cognitions predict changes in posttraumatic stress disorder symptoms during cognitive processing therapy.

Abstract: Findings support the hypothesized underlying mechanisms of CPT in showing that change in trauma-related cognitions precedes change in PTSD symptoms. Results suggest that reduction of depression may be important in influencing reduction of PTSD among veterans in residential PTSD treatment.

Cited by 134 publications

References 24 publications

Do changes in trauma-related beliefs predict PTSD symptom improvement in prolonged exposure and sertraline?

Do changes in trauma-related beliefs predict PTSD symptom improvement in prolonged exposure and sertraline?

Depression Suppresses Treatment Response for Traumatic Loss–Related Posttraumatic Stress Disorder in Active Duty Military Personnel

Response to Cognitive Processing Therapy in Veterans With and Without Obstructive Sleep Apnea

Contact Info

Product

Resources

About